Three decades of research has shown that parent training can improve developmental outcomes for children. Recent research suggests that parent training can also reduce child abuse and neglect, especially when the training is embedded in a broader community campaign. Parent training and community campaigns warrant further rigorous experimental evaluation to determine cost-effectiveness. This policy brief presents a strategy for testing community-developed parent training initiatives. Such a test will generate knowledge of the feasibility of different approaches to reducing child maltreatment and promoting child development.
More than 3 million American children are investigated for child maltreatment each year, and 800,000 children—about one in every hundred—are identified by state agencies as having been abused or neglected. More than 1,500 children die as a result of this maltreatment. The damage to children is most often inflicted by their parents—many, if not most, of whom are overwhelmed by a sense of parental frustration and failure. Indeed, the problem of difficult relationships between parents and children extends far beyond the millions of parents and children who come to the attention of child protection officials each year. Child maltreatment, the most extreme outcome of poor parenting, seriously impairs the mental health and disrupts the development of children. But research shows that parenting that is problematic without reaching the level of maltreatment can also lead to seriously negative educational and mental health outcomes for children.
As one of the authors (Barth) discusses in detail in an article in the latest volume of The Future of Children, developmental scientists have put together conclusive evidence that parenting plays a pivotal role in children’s social, emotional, health, and intellectual development. If U.S. parents had access to services that improve parenting, the nation would witness not only a decline in abuse and neglect – as welcome as that would be – but also a boost in child development for a broad range of children as manifested in higher school achievement, less delinquency, fewer teen pregnancies, reduced child mental illness, and a host of other positive outcomes. Moreover, improved parenting could enhance the lives of parents themselves by reducing the incidence of depression and, especially for low-income parents, upgrading employment prospects.
Social science has accumulated a great deal of evidence about how to improve parenting. Indeed, it is now possible to make a strong case that parent education programs can lead to better parenting all along the continuum of caretaking effectiveness, thereby achieving widespread gains in child development long sought by researchers and policy makers. Our purpose here is to explain why these gains are now within reach and to propose an initial national strategy to move the nation toward community-wide programs that can improve parenting, thus reducing child maltreatment and enhancing child development.
Evidence on Parenting
Three related programs have been repeatedly tested, mostly in small-scale studies, and found to improve parenting and child outcomes. The first, Parent Management Training (PMT), a science-informed approach to successful parenting of young children, has now been developed in multiple sites for more than thirty years. Although PMT has most often been used to help parents with children engaged in seriously disobedient or destructive behavior, the approach has also helped many families struggling with child abuse and neglect. PMT has been used with many populations and adapted in many ways. Recently, a nine-year follow-up of a randomized clinical trial, directed by Marion Forgatch, Gerald Patterson, and David DeGarmo, involving divorced mothers and their sons, showed that PMT significantly reduced teacher-reported delinquency and police arrests for boys whose mothers received training. As predicted, the training resulted in better parenting practices and fewer contacts with deviant peers which, in turn, were the mechanisms for reducing rates of adolescent delinquency.
The second program, Parent-Child Interaction Therapy (PCIT), was derived from PMT and has been successfully tested with children and families involved with child welfare services. Mark Chaffin and his colleagues at the University of Oklahoma found that PCIT significantly reduced the recurrence of child maltreatment and related service costs among physically abusive families of elementary school children. PCIT provides very explicit coaching to parents—often by having observers communicate with parents over a headset—about how to use a variety of parenting skills. PCIT may be the only parenting intervention that requires families to show competency in using a range of effective parenting skills before completing the program (for most parenting programs, completion is based on attendance, not performance). Chaffin and his colleagues estimated that implementing PCIT—thus saving money that would otherwise be spent for subsequent maltreatment reinvestigations and re-opened cases and other services—resulted in a saving of $3,427 per family, not counting further saving in developmental and health services attendant on higher rates of recurrent abuse. A recent analysis by Matthew Goldfine and his colleagues of the cost-effectiveness of PCIT in reducing child conduct and mental health problems found that PCIT was an effective and financially viable form of treatment for child disruptive behavior disorders.
The third program—and the most ambitious expansion of PMT-based parent education—is the Triple P-Positive Parenting Program, a parenting campaign that has been under development for two decades in Australia and that has just completed a successful trial in South Carolina. Conducted by Ron Prinz of the University of South Carolina, this first large-scale American trial of Triple P directly addressed, and affirmed, the success of the program in reducing substantiated child maltreatment, out-of-home placements of maltreated children, and maltreatment injuries. Triple P, following the classic model of a public health campaign, begins with a broad information program aimed at the general public about basic tenets of positive and successful parenting. The public campaign invites concerned and interested parents to get more information by attending parenting events, discussions, and conferences; offers group-based interventions for parents with specific interests and concerns; and provides in-depth treatment for parents who have children with serious conduct problems or who have serious problems of their own. The Triple P approach is community-oriented and engages professionals from multiple disciplines and service sectors and offers a common understanding, vocabulary, and treatment approach. As a result, parents and children receive more consistent and uniform services than would otherwise be available. Although a comprehensive cost-effectiveness analysis is not yet available, the costs of the universal media and communication component totaled less than $1.00 per child in the South Carolina trial. The costs of training service providers to deliver Triple P were also quite modest ($11.74 on a per child basis).
Other PMT-derived programs—for example, Project SafeCare in Oklahoma—have also shown significant promise for reducing child maltreatment in randomized clinical trials at the state and local level. With states and counties showing increased interest in adopting evidence-based methods for preventing or reducing child maltreatment and for parent training of families involved with child welfare services, it is now time to test this array of science-informed and promising parent training programs and program components on a national scale. The tests should consist of random-assignment demonstrations that measure the effects either of whole programs, such as Triple P, or of composite programs made up of elements that previous research has proved successful. Although researchers have not yet compared a continuum of science-informed parenting programs with treatment as usual or with Triple P, it is worth testing composite programs made up of selected elements known to be important to parent training. Agencies of various sizes and resource bases need scalable options for improving parent training. Finding ways to combine the elements of effective programs to address specific community needs and build on what local service providers are already doing could lead to better services at a reasonable cost without requiring communities to adopt entirely new programs.